chronic airway disease, mucus rheology and exacerbations

Conditions: Chronic Obstructive Pulmonary Disease

Summary: the main objective of this trial is to compare the exacerbation number over 12 months of follow-up between a group of patients with copd treated according to standardized management (azithromycin prescribed in the event of severe sputum according to the casa-q score , standardized comparator arm) and a similar group in which azithromycin is prescribed based on mucus rheology (experimental arm) or casa-q.

the secondary objectives are to compare between the 2 arms: * exacerbation number according to their severity (observed throughout the duration of the study); * the evolution of the symptoms, the rheology of the sputum, and the pulmonary function (measurements repeated every three months); * medication consumption and adverse events (monitored throughout the duration of the study); * patient trajectories during follow-up; * the overall clinical improvement at the end of the study and the evolution of the quality of life (measurements repeated every 3 months); * the change in biomarkers of interest (baseline versus end of study).

Eligibility criteria:
inclusion criteria: * subjets between 40 - 85 years (included) * written and signed informed consent form * subjects must be able to attend all planned visits and comply with all test procedures * beneficiary of or affiliated with the french social security system * man or woman with chronic obstructive pulmonary disease for at least 1 year defined according to global initiative for chronic obstructive lung disease (gold) criteria and validated by the clinical investigator * optimal treatment according to gold class severity c or d recommendations * \>=3 exacerbation (regardless of severity: mild-moderate-severe) or ≥ 1 severe exacerbations (requiring hospitalization) in the past 12 months * spontaneous or induced sputum production * electrocardiogram: corrected distance between q and t waves (qtc) \<450 ms in men, qtc \<470 ms in women * normal audiogram for age or absence of contraindication to azithromycin for long course according to oto-rhino-laryngological specialist opinion exclusion criteria: * pregnancy or breastfeeding * patients who are prisoners or under other forms of judicial protection * patients under any form of guardianship * participation in another interventional protocol, (current or during the month preceding inclusion) * received azithromycin in the past 3 months * patient whose primary diagnosis is bronchial dilation based on ct scan documentation * known hypersensitivity to azithromycin, erythromycin, any other macrolide, ketolide or any of the excipients of the azithromycin-based specialty used * concomitant use of medication contraindicated with azithromycin (dihydroergotamine, ergotamine, cisapride, colchicine) * other respiratory diseases or associated lung infections * severe hepatic insufficiency and severe cholestasis (a liver biological test will be carried out if clinical suspicion) * renal impairment with creatinine clearance \< 40 ml/min * patients with hematological malignancies who have undergone allogeneic hematopoietic stem cell transplantation * patients with galactose intolerance, lapp lactase deficiency or glucose or galactose malabsorption syndrome (rare hereditary disease) due to the presence of lactose in the specialty zithromax.